Pheochromocytoma and paraganglioma : Importance of diagnostic imaging

If pheochromocytoma (PC) or paraganglioma (PGL) is diagnosed based on serologic studies, imaging is required to locate the adrenal mass for further management. Besides pathognomonic hormonal findings, PC/PGL can exhibit typical imaging features. However, PC/PGL can also show morphological overlap wi...

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Bibliographic Details
Published in:Radiologe 2019-11, Vol.59 (11), p.975-981
Main Authors: Kunz, W G, Auernhammer, C J, Nölting, S, Pfluger, T, Ricke, J, Cyran, C C
Format: Article
Language:ger
Subjects:
Adrenal Gland Neoplasms - diagnostic imaging
Diagnosis, Differential
Humans
Paraganglioma - diagnostic imaging
Pheochromocytoma - diagnostic imaging
Positron Emission Tomography Computed Tomography - methods
Positron-Emission Tomography - methods
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Summary:If pheochromocytoma (PC) or paraganglioma (PGL) is diagnosed based on serologic studies, imaging is required to locate the adrenal mass for further management. Besides pathognomonic hormonal findings, PC/PGL can exhibit typical imaging features. However, PC/PGL can also show morphological overlap with other pathologies. The modality of choice for evaluation of PC is CT. In case of extra-adrenal location, MRI is superior to CT. Imaging with PET-CT provides complementary information in the differentiation of PC/PGL and is recommended as the imaging modality of choice for malignant PC/PGL. Ga-DOTATATE (or Ga-DOTATOC/ Ga-DOTANOC) PET-CT has high sensitivity for SDHx-mutated PC/PGL and serves for planning of radioreceptor therapy with somatostatin analogues. In contrast, I-metaiodobenzylguanidine (MIBG) scintigraphy is important in assessing the potential efficacy of radioreceptor therapy with MIBG. The CT protocol for PC evaluation should include non-enhanced, arterial, portal-venous and late phases; the latter for the evaluation of wash-out. Recent studies indicate non-enhanced CT alone may be sufficient to rule out PC. For MRI, in- and opposed-phase sequences should be additionally acquired. A relevant proportion of PC is diagnosed incidentally. Therefore, imaging of PC will gain further importance. Recent studies show better response rates of PC/PGL after radioreceptor therapy with somatostatin analogues ( Lu-DOTATATE) than with MIBG. Therefore, Ga-DOTATATE PET-CT gains further importance-for diagnostic imaging and therapy planning.
ISSN:1432-2102
DOI:10.1007/s00117-019-0569-7